ketorolac

10 December 2015

Toradol for Migraine

In certain cases, Toradol for migraine is a good option. But there are some risks and side effects that should be considered.

Toradol is actually a brand name, one of many, for ketorolac tromethamine. There are many other brand names, although Toradol may be the most familiar. Toradol for Migraine

Ketorolac belongs to a group of drugs known as NSAIDs – nonsteroidal anti-inflammatory drugs. Other drugs in this category include ibuprofen and fenoprofen.

Toradol for migraine is probably most useful as an emergency treatment at the hospital. Ketorolac, along with diclofenac, are both recommended in the emergency department, although they are not necessarily the first option to try (see Sequence of Treatments in Emergency â€“ what works?).

In the journal Neurology‘s evidence-based guidelines, ketoprofen is one of the higher rated NSAIDs, considered to be “probably effective” according to clinical trials. There are, however, better treatments that should be tried first.

Common side effects with Toradol for migraine include swelling (in feet, ankles, face) and weight gain. As with most NSAIDs, there may be stomach issues such as diarrhea, nausea and stomach pain. Older adults seem to be more sensitive to side effects of ketorolac. It is not recommended for use during pregnancy.

There are some serious side effects, and your risk increases if you take the medication for a longer period of time. Usually ketorolac is recommended for one-time use in the emergency room, or for a brief time (a day or two) to stop a migraine attack at home.

To avoid some stomach related issues, a nasal spray may be prescribed (SPRIX).

If prescribed by your doctor, temporary use of ketorolac may help stop a migraine attack, and is often combined with other medications. However, it’s only a temporary solution.

For more information, see:

Ketorolac (Drugs.com)
Toradol for Migraine (MAGNUM)

17 April 2014

Sequence of Treatments in Emergency – what works?

James Medications, Tips, Treatments 2

One of the most difficult challenges for someone in the middle of a migraine attack is surviving the emergency room/department. By this time, your symptoms are so severe you can hardly think straight, and you went to the ER/ED and – you get a million questions, bright lights, strange smells, and treatments that don’t work.

*sigh*

So we want to do all we can to make the visit to the hospital easier for you.

Recently, Dr. Alexander Mauskop of the New York Headache Clinic suggested a sequence of treatments – a sequence that you can recommend to the doctor.

His advice especially has to do with someone who has been throwing up, and needs hydration.

Here’s a brief summary of the sequence he recommends, with some comments of my own. You can read his whole article at: What to ask for if your migraine lands you in the emergency room.

Intravenous hydration with at least 1 gram of magnesium added to the intravenous fluids: This really gives an excuse to get the magnesium. Magnesium is a common and helpful migraine treatment in emergency, and can relieve a number of migraine symptoms on its own (see this study). This approach has recently been questioned, and may work better in some cases than others.
Sumatriptan (Imitrex) injection: Best case scenario – you’ve already taken a sumatriptan injection before coming to the hospital. If you haven’t, ask for it. But of course be sure the doctor knows what you’ve already taken.
Ketorolac (Toradol): This is one of the recommended treatments in the new guide from the Agency for Healthcare Research and Quality in the USA and the University of Alberta Evidence-based Practice Center in Canada. Access their recommendations here.
Metoclopramide (Reglan): Only if you’re nauseus.
If the above treatments don’t help after a reasonable length of time, the doctor may try dexamethasone (Decadron) and DHE-45 (dihydroergotamine).

Dr. Mauskop emphasizes that you should not be starting your treatment with divalproex sodium (Depakene) or an opioid (such as Demerol).

Certainly these guidelines aren’t the magic bullet for everyone, but it’s good to have a place to start, and this sequence is based on some of the latest research.

Of course, you’re not going to want to go through a big explanation with clinic trials at your fingertips when you’re in emergency. Why not make up a card which you can bring in, explaining the medications you currently take, and the recommended sequence, with links to information like the Effective Health Care Program Guide? It might help you get better treatment faster, and you’ll only have to answer dozens of questions instead of millions.

25 May 2010

A New way to take Toradol

James Medications, News 1

Toradol is actually a brand name, but I mentioned it in the title because people are more familiar with that name. It’s also sold as Acular, Glicima, Supradol, Apo-Ketorolac, Ketanov and Ketorol.

The actual name of the drug is ketorolac tromethamine, or simply ketorolac. Most commonly it’s given as an oral tablet or injection.

But there’s a new way to take ketorolac, and it has a new name – Sprix. Sprix comes from ROXRO PHARMA, Inc.

What makes Sprix special? It’s a nasal spray. Nasal sprays may be an easier alternative particularly for those who are tired of taking injections.

Ketorolac is non-narcotic, a non-steroidal anti-inflammatory drug (NSAID). It’s often used for fever and moderate to severe pain relief. Obviously as an anti-inflammatory it’s helpful for reducing swelling and inflammation.

It’s not usually recommended for chronic conditions, however is an option for short term pain relief (usually up to 5 days).

Sprix is not yet available, but was just approved on the 17th of May (2010) by the FDA in the United States, so it should be available soon and will probably be a well accepted alternative to other forms of ketorolac.

For more on Sprix, including the official press release, visit the Sprix website.

24 June 2005

NSAIDs – better and worse than we thought

James Discoveries & Stats, Medications 1

As the Cox-2 debate continues, other NSAIDs (nonsteroidal anti-inflammatory drugs)are coming under the microscope. And guess what? There’s good news and bad news.

NSAIDs are still safer than many other drugs, as far as we know. But there is increasing concern about some of the heart risks, even in "traditional" NSAIDs, on top of the concern about stomach problems. It’s all a good reminder that even though a drug may be "generally safe", that doesn’t mean you can take it as much as you want and not do damage.

There is good news, however. Rami Burstein, an associate professor at Harvard Medical School and vice chairman of research of the Department of Anesthesia and Critical Care at Beth Israel Deaconess Medical Center authored a study on use of NSAIDs for migraine in the emergency room. The conclusion of the researchers was that intravenous NSAIDs (ketorolac – brand name Toradol) were as effective (if not more) as the narcotics that are often given to migraineurs. Compared to the narcotics, the NSAIDs are considered to be safer and are also less habit forming. But the dosage had to be intravenous to properly work on the nervous system.

According to a 1998 study, over half of migraineurs are given narcotics without even being told of their other choices. There are more and more options, most of them safer.

The patients in Burstein’s study had allodynia – a hypersensitivity of the skin that often occurs with migraine. Previous studies indicate that triptan class drugs aren’t very effective in these cases. 64% of patients were pain free within an hour of getting the ketorolac. The others all had a history of using opioids. “This immediately raised a red flag regarding treating migraine patients with opioids, which we believe is wrong practice,” Burstein said. May this be another step to better treatments.